Einfluss der Alzheimer-Erkrankung auf die Schmerzverarbeitung

Zusammenfassung

Aus klinischen Studien ist hinlänglich bekannt, dass Patienten mit Morbus Alzheimer im Vergleich zur Altersgruppe deutlich weniger über Schmerzen berichten. Über die zugrunde liegenden Mechanismen des verminderten Schmerzberichtes weiß man hingegen nur wenig. Zu ihrer Aufdeckung sind experimentelle Studien unabdingbar, da hier Noxe und Schmerzerleben unabhängig voneinander zu erfassen sind. Wir berichten deshalb in dieser Übersichtsarbeit über experimentelle Befunde zum Schmerzerleben bei Alzheimer-Patienten. Es zeichnet sich ab, dass die Schmerztoleranzschwelle deutlich erhöht und die vegetative Schmerzreaktion teilweise erheblich vermindert ist. Die Schmerzschwelle und schmerzkorrelierten Hirnpotenziale zeigten sich hingegen weitestgehend unverändert. Wir diskutieren als mögliche Erklärungen hierfür altersbedingte Veränderungen des Schmerzerlebens und neuroanatomische Veränderungen im Rahmen der Alzheimer-Erkrankung. Insbesondere Atrophien im limbischen System könnten einen modifizierenden Einfluss auf das Schmerzerleben nehmen. Auch der Einfluss von alzheimerbedingten Einbußen in der Fähigkeit zur Schmerzkommunikation wird diskutiert.

Abstract

It is well known that patients with Alzheimer's disease report less pain in comparison to their age group. However, little is yet known about the underlying mechanisms causing the decreased pain report. In order to learn more about these mechanisms, experimental studies are indispensable, since only in experimental settings, noxious input and pain experience can be assessed independently. We therefore report on experimental data on pain perception in Alzheimer's disease in this review. The experimental data suggest that the threshold for pain tolerance is markedly increased and the autonomic pain reaction is, at least in part, considerably diminished. On the other hand, pain threshold and pain event-related brain potentials remain largely unchanged. As possible explanations we discuss age-related changes in pain perception and neuroanatomical changes in Alzheimer's disease. Particularly the atrophy of limbic structures may have a modifying impact on the pain experience. We also discuss what influence communicational deficits have on pain report.

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1 Unter Schmerzbericht wird hier die verbale Äußerung von klinischen Schmerzen jedweder Genese verstanden.